Women's Health

Ovarian Cancer Odds Lowered with Fiber, Low-Fat Diet

Older women who stick to a low-fat, high-fiber diet could cut their odds for ovarian cancer, according to a report in the Journal of the National Cancer Institute.

In fact, postmenopausal women who stayed on the regimen for more than eight years reduced their risk for the disease by 40 percent, researchers say.

Those who saw the greatest benefit from the low-fat diet were women who had originally eaten a relatively high-fat diet, the researchers add.

On average, the women had managed to add one serving of fruits or vegetables to their daily diet by end of the six-year follow-up. They had also reduced their daily fat consumption by about 8 percent.

The findings support "the idea that lifestyle changes can be made with intensive help," says Dr. Robert Morgan, section head of medical gynecologic oncology, City of Hope Cancer Center. He was not involved in the study.

Dr. Morgan notes that many of his patients ask him about ways they can reduce their cancer risk through diet and exercise. But he says he's found that "it's difficult to change habits, especially if they are longstanding."

Long-Term Adherence to Diet a Plus

According to Dr. Morgan, women have a 2 percent risk of getting ovarian cancer over their lifetime, so the relatively small benefit effect shown over the course of this study should be magnified over a lifetime.

Besides helping curb cancer, such a diet would also be beneficial in reducing the risk of other chronic diseases, such as heart disease.

The new multi-center study was led by Dr. Ross Prentice of the Fred Hutchinson Cancer Research Center in Seattle. The findings come on the heels of a similar study released by the same group in April.

That study found that increased consumption of fruits and vegetables helps reduce the risk of head and neck cancers.

The same team has also shown that low-fat diets cut the odds of breast and colorectal cancers. Prior to the publication of this analysis, the impact of particular diets on ovarian cancer was unknown.

In the study, Dr. Prentice's team recruited almost 50,000 postmenopausal women between 50 and 79 years old. Almost 20,000 of those women were randomly assigned to eat a low-fat diet in which fat intake totaled less than 20 percent of daily calories.

They also ate at least five servings of fruits and vegetables a day and at least six servings of whole grains.

The women received 18 diet-support group sessions in the first year to help keep them on track and then quarterly maintenance meetings during the following years.

The researchers then monitored the women's rates of ovarian and/or endometrial malignancies over the next eight years.

The result: Rates of ovarian cancer were roughly similar for women during the first four years of the study, whether they were enrolled on the low-fat diet or not.

But by the end of more than eight years of follow-up, a clear trend emerged, with women on the healthier diet having a 40 percent reduction in ovarian cancer incidence.

There was no such effect on the risk of endometrial cancer, however, the researchers add. That was surprising, explains Dr. Morgan, because some experts theorize that fat increases estrogen levels in the body, which, in turn, may boost risk for both ovarian and endometrial cancer.

Previous reports have indicated that low-fat diets lower circulating estrogen, says Dr. Morgan, so he expected to see a similar effect for both tumor types.

Women looking to duplicate the diet in their own lives should follow the Food Pyramid guidelines set out by the US Department of Agriculture, says Dr. Morgan.

But he added that one of the components that made this study so unique was the intense dietary counseling and support the women received over time.

According to Dr. Prentice, the diet was developed especially for this research and does not follow any contemporary "popular" diets.

"In particular, the Women's Health Initiative intervention did not have a goal of restricting energy [calorie] consumption, though participating intervention group women did lose some weight. Nor was there an attempt to reduce carbohydrates," says Dr. Prentice. "On the contrary, most of the reduced dietary fat was replaced by complex carbohydrates."

Reduction in Obesity with Low-Fat Food

The potential link between dietary fat and cancer is not fully understood, he adds.

During the study, Dr. Prentice says the researchers did note lower levels of estradiol - an estrogen hormone produced by the ovaries - in the blood of dieting women. Estradiol is an important risk factor for cancer among women, he notes.

"This or other circulating hormones could have a stimulatory effect on epithelial [blood vessel] tissue in the ovary or breast, possibly including effects on cells in yet undiagnosed cancers," says Dr. Prentice.

"The evidence for reductions in ovarian and breast cancer is strongest among women whose usual [prior] diet was relatively high in fat (e.g., more than 35 percent of calories) who made a comparatively large fat reduction if assigned to the low-fat diet group," he adds.

There is an increasing amount of evidence linking healthier diets and exercise to lower cancer risk.

But Dr. Prentice says he would like to see more basic science research focused on the ways in which these lifestyle changes affect the biochemical mechanisms that drive cancer.

Physicians Develop Detection Guidelines

In other recent news about ovarian cancer, the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists have agreed on a set of symptoms that can be signs of early ovarian cancer.

"We want people to know it's not the silent killer, says Dr. Linda Duska, a member of the National Ovarian Cancer Coalition medical advisory board and a gynecologic oncologist at Massachusetts General Hospital Cancer Center.

The screening test developed late last year involves an extensive checklist of symptoms and their frequency. It picked up early stage ovarian cancer 56.7 percent of the time, and late stage ovarian cancer 80 percent of the time.

The test also produced "false-positive" findings 10 percent to 13 percent of the time. The test searches for many of the symptoms agreed upon by cancer experts as indicative of ovarian cancer.

The symptoms of ovarian cancer can be subtle and hard to assess, because they often mimic common digestive and gastrointestinal disorders.

They include persistent swelling, bloating, pressure or pain in the abdomen, gastrointestinal upset, difficulty eating or feeling full quickly, and the frequent or urgent need to urinate.

Because these symptoms are so common, women should be careful not to assume the worst, Dr. Duska says.

January 2008

Ovarian Cancer Facts

Ovarian cancer is the fifth leading cause of death for women from cancer. Some 20,000 women in the US are diagnosed with the disease every year, and about 15,000 women will die from it during the same time frame.

As with most cancers, a woman's chances of survival are better if the disease is found early, but ovarian tumors are a "stealth killer," because they are notoriously difficult to detect in their early stages.

The cause of ovarian cancer is unknown, but there are certain risk factors that indicate an increase in a woman's chance of developing ovarian cancer.

The following have been suggested as risk factors for ovarian cancer:

early menarche - starting monthly periods early - before the age of 12

late menopause - after the age of 52

age - over the age of 50

hormone replacement therapy
Some studies have suggested that women who use hormone replacement therapy after menopause may have a slightly increased risk of ovarian cancer.

infertility (inability to become pregnant)

having a first child after the age of 30

personal history of breast or colon cancer

family history
First-degree relatives (such as mother, daughter, sister) of a woman who has had ovarian cancer are at risk for developing the disease. The risk increases if two or more first-degree relatives have had ovarian cancer. A family history of breast or colon cancer is also associated with an increased risk of developing ovarian cancer.

certain fertility drugs

The following are the most common symptoms of ovarian cancer:

general discomfort in the lower abdomen, including feeling swollen or bloated, a loss of appetite or a feeling of fullness - even after a light meal, or gas, indigestion, and nausea

weight loss

diarrhea or constipation, or frequent urination caused by the growing tumor, which may press on nearby organs, such as the bowel or bladder

bleeding from the vagina

build up of fluid around the lungs, which may cause shortness of breath

In many cases, symptoms do not occur until the ovarian cancer is in an advanced stage.

The symptoms of ovarian cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Diagnosis includes a medical history and physical examination, including a pelvic examination to feel the vagina, rectum, and lower abdomen for masses or growths.

A Pap test may be requested as part of the pelvic examination.

The physician may also order other tests, including ultrasound, computed tomography (CT or CAT scan), lower gastrointestinal (GI) series (x-rays of the colon and rectum), intravenous pyelogram (IVP), blood test to measure a substance in the blood called CA-125 (a tumor marker that is found to be elevated in the blood of women with ovarian cancer), or biopsy (a procedure in which tissue samples are removed from the body for examination under a microscope) to determine if cancer or other abnormal cells are present. The diagnosis of cancer is confirmed only by a biopsy.

Always consult your physician for more information.

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